The nuclei are round and regular with little clefting and inconspicuous nucleoli. Chimeric antigen receptor T (CAR-T) cells, engineered and generated from the patient's T cells, induce remission in patients with relapsed ALL with remarkable efficacy, albeit with significant toxicity (2). Chronic leukemia progresses more slowly than acute leukemia, which requires immediate treatment. Patients can present with spontaneous hemorrhage, including intracranial or intra-abdominal hematomas. Blood Spotlight on iAMP21 acute lymphoblastic leukemia (ALL), a high-risk pediatric disease Christine J. Harrison Leukaemia Research Cytogenetics Group, Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, United Kingdom The nuclei are irregular and often clefted. After appropriate studies and cultures have been done, febrile patients with neutrophil counts < 500/mcL (< 0.5 × 109/L) should begin treatment with a broad-spectrum bactericidal antibiotic that is effective against gram-positive and gram-negative organisms (eg, ceftazidime, piperacillin and tazobactam, meropenem). Visualization of the classification data. Please note that THE MANUAL is not responsible for the content of this resource. Acute lymphoblastic leukemia invades your blood and can spread to other organs, such as your liver, spleen, and lymph nodes. L3: ALL blasts are moderate-large in size and homogeneous. Malignant transformation and uncontrolled proliferation of an abnormally differentiated, long-lived hematopoietic progenitor cell results in a high circulating number of blasts, replacement of normal marrow by malignant cells, and the potential for leukemic infiltration of the … Acute Lymphoid Leukemia is a type of blood cancer. Upon receipt of an executed copy of the signed application form, access instructions will be given. Each image file ImXXX_Y.jpg is associated with a text file ImXXX_Y.xyc reporting the coordinates of the centroids of the blast cells, if any. The classification of the lymphocyte in microscope images is quite complex since even an expert operator can have dubs in classifying some lymphocyte cells. ( fabio DOT scotti AT unimi DOT it ). Interim maintenance and late/delayed intensification therapy are used after consolidation therapy. Chemotherapy is the main … We hope that this initiative could give a new test tool to the image processing and pattern matching communities, Summary. ALL occurs when the bone marrow produces a large number of immature lymphoblasts. The visual examination of blood samples is a major criterion for the analysis of leukemia , . All documents and papers that report on research that uses the ALL-IDB datasets must include an appropriate citation The cancer starts in the white blood cells, or lymphocytes, within the bone marrow, which is the spongy tissue inside bones where new blood cells form. CNS prophylaxis starts during induction and continues throughout all phases of treatment. In patients already known to have ALL, these tests can help detect liver or kidney problems caused by spreading leukemia cells or the side effects of certain chemotherapy drugs. Psychologic support may help patients and their families with the shock of illness and the rigors of treatment for a potentially life-threatening condition. Childhood Acute lymphoblastic leukemia Stem cell transplant. for segmentation and image classification. Download Application Form (PDF). Testicular relapse may be evidenced clinically by painless firm swelling of a testis or may be identified on biopsy. For adults with Ph+ ALL, allogeneic stem cell transplantation is recommended as consolidation therapy. Cytoplasm is scanty and usually without vacuoles. The goal of consolidation is to prevent leukemic regrowth. Acute lymphoblastic leukemia Picture - Fotosearch Enhanced. For patients with CD20 positive B-lymphoblastic leukemia, rituximab can be added. Thrombocytopenia can cause mucosal bleeding, easy bruising, petechiae/purpura, epistaxis, bleeding gums, and heavy menstrual bleeding. Bone marrow is the soft tissue in the center of bones that helps form all blood cells. Mehrnoosh Tashakori, Joseph D. Khoury; B acute lymphoblastic leukemia arising during maintenance therapy for multiple myeloma, Blood, Volume 136, Issue 23, 3 De The volume of cytoplasm is moderate and contains prominent vacuoles. Learn more about our commitment to Global Medical Knowledge. Treatment is radiation therapy of the involved testis and administration of systemic reinduction therapy. In patients with refractory pneumonitis, Pneumocystis jirovecii infection or a viral infection should be suspected and confirmed by bronchoscopy and bronchoalveolar lavage and treated appropriately. ALL-IDB1 allows for different levels of analysis: This image set has been designed for testing the performances of classification systems. For example, older patients with several comorbidities and poor performance status may undergo gentler induction therapy without consolidation or maintenance. ; Symptoms and signs of C-ALL include. "Acute" refers to the way the cancer progresses quickly. The legacy of this great resource continues as the MSD Manual outside of North America. Interruption or stopping blinatumomab with or without use of high-dose dexamethasone may be necessary. Bone marrow relapse is particularly ominous. Nilotinib combined with multiagent chemotherapy for newly diagnosed Philadelphia-positive acute lymphoblastic leukemia. Acute lymphoblastic leukemia (ALL) is a fast-growing cancer of a type of white blood cell called a lymphoblast. This cancer is not preventable, detection in the initial phases and swift treatment … probable lymphoblasts from ALL patients (d-f). Acute lymphoblastic leukemia (ALL) is a cancer of the lymphoid line of blood cells characterized by the development of large numbers of immature lymphocytes. and Y is a boolean digit equal to 0 is no blast cells are present, and equal to 1 if at least one blast cell is present in the image. Other laboratory findings may include hyperuricemia, hyperphosphatemia, hyperkalemia, hypocalcemia, and elevated lactate dehydrogenase (LDH), which indicate a tumor lysis syndrome. How is ALL treated? The main goal is to detect without differentiation the presence of all three types of blasts in the images. Bone marrow smear in T-cell acute lymphoblastic leukemia shows pleomorphic blasts cells and smear cells. Y is a boolean digit equal to 0 if the cell placed in the center of the image is not a blast cell, Cranial nerve or whole-brain irradiation was previously often done for patients at high risk of CNS disease (eg, high WBC count, high serum lactate dehydrogenase, B-cell phenotype), but its use has been decreasing in recent years. Anemia can manifest with fatigue, weakness, pallor, malaise, dyspnea on exertion, tachycardia, and exertional chest pain. Key Terms. Which of the following immunotherapy approaches has demonstrated great potential in early clinical trials in patients with B-cell leukemia? immature/lymphoblastic lymphoma. Like all leukemias, it is a cancer of blood-forming cells in the bone marrow. *Childhood acute lymphoblastic leukemia (ALL) facts medical author: Melissa Conrad Stöppler, MD Childhood acute lymphoblastic leukemia (C-ALL) is a common type of cancer in children. Common cytogenetic abnormalities in ALL include t(9;22) in adults and t(12;21) and high hyperdiploidy in children (see table Common Cytogenetic Abnormalities in ALL). In younger adults, a regimen that includes asparaginase and/or cyclophosphamide for induction, similar to treatment protocols used in children, may increase rates of response and achievement of undetectable minimal residual disease. Example of ALL blast cells recognition by segmentation and single cell classification. One or more, usually large nucleoli are present. To diagnose ALL, the hematologists perform blood and bone marrow examination. Bone marrow is the soft tissue in the center of bones that helps form all blood cells. The cancerous blood cells then overrun the normal blood cells. See more ideas about acute myeloid leukemia, cancer sucks, leukemia. What Is It? ALL is characterised by an overproduction of immature white blood cells, called lymphoblasts or leukaemic blasts. Bone marrow examination (aspiration and needle biopsy) is routinely done. Acute lymphocytic leukemia is also known as acute lymphoblastic leuk… Acute lymphoblastic leukemia treatment. If unilateral testicular involvement is clinically evident, the apparently uninvolved testis should undergo biopsy. It is a rare form of cancer with an incidence of 1.7 cases per 100,000 people, based on data from 2011 to 2015. Fungal infections, especially pneumonias, are becoming more common; these infections are difficult to diagnose, so chest CT to detect fungal pneumonia should be done early (ie, within 72 hours of presentation with neutropenic fever, depending on the degree of suspicion). Acute lymphocytic leukemia (ALL) develops when abnormal white blood cells accumulate in the bone marrow. Organ infiltration by leukemic cells results in enlargement of the liver, spleen, and lymph nodes. k62485644 Fotosearch Stock Photography and Stock Footage helps you find the perfect photo or footage, fast! OBJECTIVE: A review of the literature on Tregs in acute leukemias was conducted and Tregs were determined in B-cell acute lymphoblastic leukemias (ALLs). The initiative is focused on Acute Lymphoblastic Leukemia (ALL), a serious blood pathology The 2016 World Health Organization (WHO) classification of lymphoid neoplasms incorporates genetic data, clinical features, cell morphology, and immunophenotype, all of which have important implications for disease prognosis and management. In acute lymphoblastic leukemia, the precursor lymphoid neoplasms are broadly categorized based on their lineage into, B-lymphoblastic leukemia/lymphoma (B-ALL/LBL), T-lymphoblastic leukemia/lymphoma (T-ALL/LBL). Leukemia is a type of blood cancer that develops in bone marrow, where blood cells are made. Bone marrow tests Other tests will be done to … The following is an English-language resource that may be useful. Listen. Because hyperdiploid ALL samples also … Early intervention and quick treatment can give better results. The ALL_IDB1 version 1.0 can be used both for testing segmentation capability of algorithms, as well as the classification systems and image preprocessing methods. The images of the dataset has been captured with an optical laboratory microscope coupled with a Canon PowerShot G5 camera. Elevated serum hepatic transaminases or creatinine, and hypoglycemia may also be present. According to the most common visual morphological analysis for the ALL disease (the FAB method, see related publications), the features that trained lab technicians consider during the image observation are the following: Next figure shows the great variability in shape and pattern of the blast cells according to the FAB classification for the ALL disease. It is estimated to account for about 0.3% of all the new cancer cases in 2018 with the total number of cases estimated to be around 6000. Last full review/revision May 2020| Content last modified May 2020. Micrograph of acute myeloid leukemia Micrograph of acute myeloid leukemia (AML), also known as acute myelogenous leukemia or acute nonlymphocytic leukemia (ANLL), is a cancer of the myeloid line of blood cells, characterized by the rapid growth of abnormal white blood cells that accumulate in the bone marrow and interfere with the production of normal blood cells. Enlarge Anatomy of the bone. Leukemia can be either acute or chronic. Adult acute lymphoblastic leukemia (ALL; also called acute lymphocytic leukemia) is a cancer of the blood and bone marrow. It's the most common type of childhood cancer. Life-threatening toxicities may include cytokine release syndrome and neurologic toxicities (eg, seizures, encephalopathy with altered consciousness, and disordered speech, coordination, and/or balance). There is a significant drug-drug interaction between vincristine, which is commonly used in all ALL treatment regimens, and azole antifungals. We propose a new public and free dataset of microscopic images of blood samples, specifically designed for the evaluation and the comparison of algorithms Most regimens include maintenance therapy with monthly vincristine, weekly methotrexate, daily mercaptopurine, and 5 days/month corticosteroid. The relationship between acute lymphoblastic leukemia (ALL-L3) and stage IV small noncleaved cell lymphoma with bone marrow involvement (SNCL) was analyzed by retrospective study of 45 patients. ALL is the most common type of cancer and leukemia in … Normally, the bone marrow makes blood stem cells (immature cells) that develop into mature blood cells over time. Leukemia is also classified as lymphocytic or myelogenous. N Engl J Med 375(8):740–753, 2016. In the literature, the identification and classification of white blood blast cells had been tackled by a classic sequence of steps as shown in the next figure. Although a diagnosis of acute leukemia can be made from blood and bone marrow ... at one end of the spectrum you have primary bone marrow involvement which dominates the clinical picture or an ALL. Repeat induction chemotherapy, immunotherapy, and stem cell transplantation may be helpful for relapse. Lancet385(9967) :517–528, 2015. Antibodies, such as blinatumomab, that bring T cells into close proximity to leukemic blasts demonstrate activity in relapsed ALL. Because the bone marrow is unable to make adequate numbers of red cells, normal white cells and platelets, people with ALL become more susceptible to anaemia, … This type of cancer usually gets worse quickly if it is not treated. The centroids stored in the ''Im006_1.xyc'' are plotted on the input image ''Im006_1.jpg'' as crosses to indicate the position of probable ALL lymphoblasts. Activating mutations of the FLT3 receptor tyrosine kinase are common in acute myelogenous leukemia (AML) but are rare in adult acute lymphoblastic leukemia (ALL). Example of the ALL-IDB1 annotation: input image ''Im006_1.jpg'' (a) and the related classification file ''Im006_1.xyc'' reporting the coordinates of the centroids of probable ALL lymphoblasts (b). A blood stem cell may […] In patients with complete remission, a low measurable residual disease (also known as minimal residual disease or MRD) is the most important prognostic factor (1). Malignant transformation usually occurs at the pluripotent stem cell level, although it sometimes involves a committed stem cell with more limited capacity for self-renewal. It is the most common form of childhood cancer. About 3,000 children and teens younger than 20 are diagnosed with ALL each year in the United States. The neoplastic cells are not invariably large. © 2020 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA), © 2021 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. Leukemic cells may reappear in the bone marrow, CNS, testes, or other sites. If left untreated, death can occur … The ALL-IDB1 image files are named with the notation ImXXX_Y.jpg where XXX is a 3-digit integer counter Kim DY, et al; Adult Acute Lymphoblastic Leukemia Working Party of the Korean Society of Hematology. The Tettamanti Research Center is part of the Tettamanti Foundation, a no-profit scientific institution, involved in the area of research on childhood leukemias and hematological diseases, Blast cells in the peripheral smear may approach 90% of the white blood cell (WBC) count. May 16, 2020 - Explore David Yee's board "Acute Myeloid Leukemia" on Pinterest. It is the most common type of leukemia in children and rarely affects adults. These cells divide rapidly, replacing healthy cells and, in some cases, invade healthy organs. k61437114 Fotosearch Stock Photography and Stock Footage helps you find the perfect photo or footage, fast! Other agents that are available, but for which clinically meaningful outcomes have not been convincingly demonstrated, include, Liposomal vincristine (a vinca alkaloid): For adults with Ph- ALL in at least 2nd relapse or that has progressed despite ≥ 2 antileukemia therapies, Clofarabine (a purine nucleoside analog): For patients age 1 to 21 years with relapsed or refractory ALL after ≥ 2 prior regimens, Nelarabine (a purine nucleoside) analog prodrug of guanosine arabinoside: For T-cell ALL that has not responded to or has relapsed after ≥ 2 prior regimens. Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer; it also strikes adults of all ages. Examples of the images contained in ALL-IDB2: healthy cells from non-ALL patients (a-d), Chromosomal abnormalities are increasingly used to risk stratify adults with acute lymphoblastic leukemia. Examining blood microscopic images for leukemia is necessary when expensive equipment for flow cytometry is unavailable. The ALL-IDB initiative is sustained and maintained by. To the best of our knowledge, the image level test for acute lymphoblastic leukemia (ALL) recognition was performed on the proposed system for the first time that achieves the best accuracy rate of 89.81%. Factors contributing to poorer clinical outcomes in adults compared with children include the following: Less ability to tolerate intensive chemotherapy, Higher risk ALL genetics that confer chemotherapy resistance, Poorer adherence to ALL treatment regimens, which include frequent (often daily or weekly) out-patient chemotherapy and doctor visits, Less frequent use of pediatric-inspired treatment regimens. Please note that all images labeled with Y=0 are from for healthy individuals, and all images labeled with Y=1 are from ALL patients. Granulocyte transfusions are not routinely used. CT of the chest and abdomen should be done to detect mediastinal masses and lymphadenopathy and may also detect hepatosplenomegaly. The blood smear sample can also be used for cytogenetic analysis and immunophenotyping, which are explained below. The nuclei are regular and round-oval in shape. These abnormal white blood cells are not able to fight infection and impair the ability of the bone marrow to produce red blood cells and platelets. Merck & Co., Inc., Kenilworth, NJ, USA (known as MSD outside of the US and Canada) is a global healthcare leader working to help the world be well. R. Donida Labati, V. Piuri, F. Scotti, ", ALL-IDB: the acute lymphoblastic leukemia image database for image processing, Robust Segmentation and Measurements Techniques of White Cells in Blood Microscope Images, Automatic morphological analysis for acute leukemia identification in peripheral blood microscope images, Morphological classification of blood leucocytes by microscope images, The image classification is correct if and only if the output CLASS is equal to Y, the output N is correct if equal to the M rows in the ImXXX_Y.xyc file. Anemia (hemoglobin <7 or 8 g/dL [< 70 to 80 g/L]) is treated with transfusions of packed red blood cells. probable lymphoblasts from ALL patients (e-h). Posaconazole, a 2nd-generation triazole antifungal drug, is indicated for primary prophylaxis in patients age > 13 years who are at high risk of developing invasive Aspergillus and Candida infections because of immunosuppression (eg, hematopoietic stem cell transplant recipients with graft-versus-host disease). Chronic leukemias typically take months or years to progress. Drop of blood with white blood cells isolated on a light background. High doses of systemic methotrexate and/or cytarabine penetrate the CNS, providing extra CNS prophylaxis if regimens include these drugs. 4. If marrow cells are insufficient or unavailable, diagnosis can be made by the same criteria using a peripheral blood sample. This approach can be followed for ALL-IDB1 and ALL-IDB2. Leukemia is cancer of the blood cells. Leukemia is also classified by the type of abnormal blood cell found most often. Prognostic factors help determine treatment protocol and intensity. Acute lymphoblastic leukemia Picture - Fotosearch Enhanced. CBC and peripheral smear are the first tests done; pancytopenia and peripheral blasts suggest acute leukemia. We observed a significantly increased percentage of Tregs (mean ± SD, 9.72 ± 3.79% vs. 7.05 ± 1.74%; P = 0.047) in the bone marrow/peripheral blood of ALL (n = … AML affects the myeloid organs, whereas ALL is seen in the bone marrow. The nonspecific nature of the signs and symptoms of ALL often leads to wrong diagnosis. All requests for the ALL-IDB datasets must be directed (by email) to Fabio Scotti Less common cytogenetic abnormalities include the following: t(v;11q23) /MLL or KMT2A rearranged, including t(4;11)/KMT2A-AF4, t(8;14), t(8;22), t(2;8)/C-MYC rearranged. The bone is made … BCR-ABL-like acute lymphoblastic leukemia overlaps genetically with ALL in which the Philadelphia chromosome [a reciprocal balanced translocation between chromosomes 9 and 22, t(9;22)] is present (Ph+ ALL). From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. We wish to thanks prof. Andrea Biondi and Dr. Oscar Maglia from M. Tettamanti Research Center -Monza, Italy- This type of cancer usually gets worse quickly if it is not treated. Examples of the images contained in ALL-IDB1: healthy cells from non-ALL patients (a-c), The abnormal lymphoblasts grow quickly and replace normal cells in the bone marrow. May 28, 2017 - Explore Holly Wagner's board "Acute Lymphoblastic Leukemia" on Pinterest. All rights reserved. The Manual was first published as the Merck Manual in 1899 as a service to the community. and equal to 1 if the cell placed in the center of the image is a blast cell. We feature 65,500,000 royalty free photos, 337,000 stock footage clips, digital videos, vector clip art images, clipart pictures, background graphics, medical illustrations, and maps. Symptoms and signs of acute lymphoblastic leukemia may be present for only days to weeks before diagnosis. A possible approach to ALL image classification. Applicants should manually fill, sign, scan and attach the application form to the given email address. We do not control or have responsibility for the content of any third-party site. Echocardiography or multi-gated acquisition (MUGA) scanning is typically done to assess baseline cardiac function (prior to administration of anthracyclines, which are cardiotoxic). For each image in the dataset, the classification/position of ALL lymphoblasts is provided … Acute lymphoblastic leukemia, 3D illustration showing abundant lymphoblasts in blood - Buy this stock illustration and explore similar illustrations at Adobe Stock Sales: 800-685-3602 Sell Transfusions of red blood cells and sometimes platelets are administered as needed to patients with bleeding or anemia. ALL is the most common type of cancer in children. The annotation of ALL-IDB2 is as follows. The American Cancer Society estimates that in the United States in 2020 there will be about 6,150 new cases of acute lymphoblastic leukemia (ALL) and about 1,520 deaths. Older ALL patients are more likely to have precursor B-cell ALL and have higher risk and more complex cytogenetics, including Philadelphia chromosome positive (Ph+) or t(v;11q23) MLL (KMT2A) rearranged disease. Acute lymphoblastic leukaemia (ALL) is a type of cancer that affects the blood and bone marrow. Acute lymphoblastic leukemia is the most common form of pediatric cancer which is categorized into three L1, L2, and L3 and could be detected through screening of blood and bone marrow smears by pathologists. The 4 general phases of chemotherapy for acute lymphoblastic leukemia include, The goal of induction treatment is complete remission, defined as < 5% blast cells in the bone marrow, an absolute neutrophil count > 1000/mcL (> 1 × 109/L), a platelet count > 100,000/mcL (> 100 × 109/L), and no need for blood transfusion. Supportive care is similar in the acute leukemias and may include. Unlike in AML, Auer rods (linear azurophilic inclusions in the cytoplasm of blast cells) are never present in acute lymphoblastic leukemia. Cells from other relatives or from matched, unrelated donors are sometimes used. Childhood acute lymphoblastic leukemia (also called ALL or acute lymphocytic leukemia) is a cancer of the blood and bone marrow. Select from premium Acute Lymphoblastic Leukemia of the highest quality. Malignant transformation and uncontrolled proliferation of an abnormally differentiated, long-lived hematopoietic progenitor cell results in a high circulating number of blasts, replacement of normal marrow by malignant cells, and the potential for leukemic infiltration of the central nervous system (CNS) and testes. Antimicrobials are often needed for prophylaxis and treatment because patients are immunosuppressed; in such patients, infections can progress quickly with little clinical prodrome. Of course, nowadays more accurate diagnostic tools area available (e.g., the immunologic classification) but they require a blood sample and, since they are not image-based, their usage in telemedicine applications is quite limited. ALL occurs when the bone marrow produces a large number of immature lymphoblasts. Tyrosine kinase inhibitor used in treatment of chronic myeloid leukemia (CML) and acute lymphoblastic leukemia (ALL). Acute lymphocytic leukemia (ALL), also known as acute lymphoblastic leukemia, is a cancer of the blood and bone marrow. The cadherin gene FAT1, located on chromosome 4q34-35 (ref. Patients with Ph+ ALL and patients with t(v;11q23) involving MLL rearrangements often present with hyperleukocytosis. Acute Lymphoblastic Leukemia (ALL) spreads out in children's bodies rapidly and takes the life within a few weeks. CNS penetration and meningeal infiltration are common and can result in cranial nerve palsies, headache, visual or auditory symptoms, altered mental status, and transient ischemic attack/stroke. These phases of therapy incorporate a variety of chemotherapeutic agents with different doses and schedules that are less intense than induction and consolidation. L2: ALL blasts are large and heterogeneous. The risk declines slowly until the mid-20s and then begins to rise again slowly after age 50. A group of cancers, including leukemia … Adult acute lymphoblastic leukemia (ALL; also called acute lymphocytic leukemia) is a cancer of the blood and bone marrow. based at the S. Gerardo Hospital in Monza, Italy. Copyright (c) 2010 Fabio scotti. Please consider this section: reporting the results . Previous chemotherapy and exposure to radiation may increase the risk of developing ALL. 126 (6):746-56. . And … Symptoms include fatigue, pallor, infection, bone pain, CNS symptoms (eg, headache), easy bruising, and bleeding. If complete remission is not achieved after induction, some regimens recommend a second induction course to try to get more patients to complete remission before consolidation. Because lymphoblasts often infiltrate the spinal fluid and meninges, all regimens include CNS prophylaxis and treatment with intrathecal methotrexate, cytarabine, and hydrocortisone in combination or as monotherapy. It contains about 39000 blood elements, where the lymphocytes has been labeled by expert oncologists. ALL is the most common cancer in children, and represents about 75% of leukemias among children < 15 years of age, and is the 2nd most common cause of death in children < 15 years. It forms when blood cells in the bone marrow malfunction and form cancerous cells. Therapy duration is usually 2½ to 3 years. Due to being time-consuming and tediousness of the … Empiric antifungal therapy should be given if antibacterial therapy is not effective within 72 hours. Acyclovir or valacyclovir prophylaxis is generally recommended for all patients. The volume of cytoplasm is variable, but often abundant and may contain vacuoles. We propose a specific set of features to be processed in order to fairly compare different algorithms tested on ALL-IDB images. About one third of patients with acute lymphoblastic leukemia are older adults (> 65). Acute lymphoblastic leukemia (ALL) in older adults presents a real challenge as a result of adverse disease biology and comorbidities that preclude delivering curative regimens. Inotuzumab ozogamicin, a CD22-directed antibody-drug conjugate with calicheamicin, is also available for adults with relapsed or refractory B-cell precursor ALL. Since the disease progress quickly creating more number of immature white blood cells, it is known as “acute” (rapidly). This dataset is composed of 108 images collected during September, 2005. Acute lymphocytic leukemia (ALL) is a type of cancer of the blood and bone marrow — the spongy tissue inside bones where blood cells are made.The word \"acute\" in acute lymphocytic leukemia comes from the fact that the disease progresses rapidly and creates immature blood cells, rather than mature ones.